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Updated: Oct 2, 2026
E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Evaluating a shared decision engagement system in the National Cancer Institute Community Oncology Research Program:
Sarah T Hawley1,2,3, Kelley M Kidwell4, Reshma Jagsi5
1Division of General Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, United States.
Background:
Improving patient-centered care and communication in breast cancer remains challenging in the complex and evolving landscape of breast cancer care delivery.
Methods:
The SharES (Alliance A231901CD) trial (ClinicalTrials.gov NCT04549571) was carried out in collaboration with the Alliance National Cancer Institute Community Oncology Research Program Research Base to evaluate a multilevel intervention in a crossed design: (1) a patient-level randomized intervention of the evidence-based iCanDecide online tool with added emotional support enhancements, intended to promote better information uptake by supporting management of distress associated with a new diagnosis vs the standard version, and (2) a clinic-level stepped-wedge randomized clinician dashboard intervention. Patient-reported outcomes assessed 5 weeks after registration were knowledge about breast cancer locoregional treatment (primary outcome), with cancer worry and breast cancer self-efficacy as key secondary outcomes. We evaluated outcomes using linear mixed models, considering the nesting of individuals within the clinic across time periods.
Results:
We enrolled 542 (403 evaluable) patients and 54 clinicians across 25 surgical clinics. The CIs for all outcomes included zero but excluded prespecified clinically important differences in the knowledge score. We found good fidelity to the intervention components and considerable variation in the primary outcome across sites.
Conclusions:
The addition of emotional support components to a patient support tool previously found effective is unlikely to result in clinically important improvements in knowledge, cancer worry, or breast cancer self-efficacy. The strong engagement of National Cancer Institute Community Oncology Research Program sites, clinicians, and patients with the study and intervention components suggests future cancer care delivery studies could use implementation strategies to promote multilevel patient-centered communication interventions.
Trial Registration:
ClinicalTrials.gov NCT04549571.
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